AIDS Case Count Called Accurate Despite Gaps in Reporting

NEW YORK (AP) _ Public health officials say they think their counts of AIDS cases are relatively accurate despite reports that some doctors don’t reveal all the cases they treat.

″We feel that reporting for AIDS is quite good, and we’re quite pleased with it,″ said Ann Hardy, epidemiologist with the AIDS program at the federal Centers for Disease Control.

Several doctors who treat AIDS patients said some colleagues don’t report some cases in people treated as outpatients, sometimes from a patient’s fear that word could reach an employer. But they also said that such patients generally end up being counted later, when they enter a hospital.

″Hospital reporting is virtually complete in New York City,″ said Dr. Dan William, a New York physician who has treated about 50 AIDS patients in the past year.

Doctors are supposed to report confirmed cases of acquired immune deficiency syndrome to health authorities when they encounter them in outpatients, but ″who’s going to enforce compliance?″ said William, who says he reports cases.

″It’s very important the statistics accurately reflect the severity of the epidemic so appropriate resources are allocated,″ he said.

Dr. Dennis Passer, another New York physician, said he reports his cases to aid research, and that he believes the number of unreported cases is not significant.

He also said some doctors occasionally avoid specifying AIDS on death certificates if the family doesn’t want the cause of death known.

Because AIDS cripples the body’s defenses against disease, the direct cause of death is actually another disease. Pneumocystis carinii pneumonia is among diseases characteristic in AIDS patients. But a doctor may list pneumonia as cause of death without specifying what type, Passer said.

″I don’t personally do this,″ he said, ″but it is done by others.″

Dr. Stephen Schultz, deputy commissioner for epidemiologic services at the New York City health department, said a study found that more than 90 percent of death certificates filed in the city for people known to have had AIDS listed immune deficiency among causes of death.

But he also said that unlike some other jurisdictions, the causes-of-death portion of death certificates filed in New York City is confidential.

CDC’s Hardy said failure to specify AIDS on the death certificate does not necessarily mean the doctor is failing to report AIDS cases.

Routine surveillance by four city health departments was finding 89 percent of AIDS cases, said Hardy, citing a recent study. That is really good, she said, adding that some estimates put reporting of venereal diseases at only 10 percent to 15 percent of cases.

Schultz said he did not think underreporting was a problem in New York City, which accounts for 31 percent of the nation’s reported cases.

One study of hospital records suggested that 90 percent to 95 percent of cases that met the CDC criteria for diagnosis were being reported, he said.

Another study showed that 13 percent of cases diagnosed as AIDS at death had not been reported earlier. Hospital records showed that they didn’t meet the strict CDC criteria for AIDS earlier, he said.

In Los Angeles County, studies show that 97 percent of AIDS cases revealed by death certificates had previously been reported, said Dr. Shirley Fannin, associate deputy director of communicable disease control in the county health department.

Researchers look not only for AIDS on the certificates, but also deaths from diseases that can strike after AIDS weakens the immune system, she said. Possible AIDS cases are confirmed by checking medical records, she said.

As of Monday, the contagious disease had been diagnosed in 21,302 people in the United States and claimed 11,645 lives, according to the CDC.